Acid-Base Disturbances Quiz

A patient has the following laboratory values: Arterial pH = 7.32 HCO3- = 10 mEq/L PCO2 = 20 mm Hg PO2 = 100 mm Hg Plasma Na+ = 140 mEq/L Cl- = 105 mEq/L

Which of the following most accurately describes the acid/base status of this patient? A. Metabolic acidosis, uncompensated B. Metabolic acidosis with compensatory respiratory alkalosis C. Metabolic alkalosis, uncompensated D. Metabolic alkalosis with compensatory respiratory acidosis E. Respiratory acidosis, uncompensated F. Respiratory acidosis with compensatory metabolic alkalosis G. Respiratory alkalosis, uncompensated H. Respiratory alkalosis with compensatory metabolic acidosis I. Combined (mixed) disorder, metabolic and respiratory acidosis J. Combined (mixed) disorder, metabolic and respiratory alkalosis

The correct answer is B. The patient has low pH (acidosis), the respiratory contribution is alkalosis (PCO2 = 20 mm Hg), and the metabolic contribution is acidosis (bicarbonate is below the level expected with this PCO2). When only one factor is in the same direction as the pH, that factor (metabolism) is responsible. Ventilation has roughly doubled, and the resulting alkalosis has moved the pH closer to normal; this is respiratory compensation. The plasma anion gap of 25 also indicates metabolic acidosis. A patient has the following laboratory values: Arterial pH = 7.48 HCO3- = 18 mEq/L PCO2 = 25 mm Hg PO2 = 105 mm Hg Plasma Na+ = 140 mEq/L Cl- = 105 mEq/L

Which of the following most accurately describes the acid/base status of this patient?

A. Metabolic acidosis, uncompensated B. Metabolic acidosis with compensatory respiratory alkalosis C. Metabolic alkalosis, uncompensated D. Metabolic alkalosis with compensatory respiratory acidosis E. Respiratory acidosis, uncompensated F. Respiratory acidosis with compensatory metabolic alkalosis G. Respiratory alkalosis, uncompensated H. Respiratory alkalosis with compensatory metabolic acidosis I. Combined (mixed) disorder, metabolic and respiratory acidosis J. Combined (mixed) disorder, metabolic and respiratory alkalosis

The correct answer is H. The patient has an alkalosis, the respiratory contribution is alkalosis (PCO2 = 25 mm Hg), and the bicarbonate is low (metabolic acidosis). Because the patient has an alkalosis, respiration is the responsible factor. The metabolic acidosis has partially corrected the pH; thus, it is a compensatory mechanism. A patient has the following laboratory values: Arterial pH = 6.84 HCO3- = 10 mEq/L PCO2 = 60 mm Hg PO2 = 55 mm Hg Plasma Na+ = 145 mEq/L Cl- = 105 mEq/L

Which of the following most accurately describes the acid/base status of this patient? A. Metabolic acidosis, uncompensated B. Metabolic acidosis with compensatory respiratory alkalosis C. Metabolic alkalosis, uncompensated D. Metabolic alkalosis with compensatory respiratory acidosis E. Respiratory acidosis, uncompensated F. Respiratory acidosis with compensatory metabolic alkalosis G. Respiratory alkalosis, uncompensated H. Respiratory alkalosis with compensatory metabolic acidosis I. Combined (mixed) disorder, metabolic and respiratory acidosis J. Combined (mixed) disorder, metabolic and respiratory alkalosis

The correct answer is I. The patient has a severe acidosis. The elevated PCO 2 indicates respiratory acidosis, and the depressed bicarbonate indicates metabolic acidosis. Both metabolic and respiratory factors are contributing to the acidosis. This is a combined, or mixed, disorder. A patient has the following laboratory values:

Arterial pH = 7.20 HCO3- = 30 mEq/L PCO2 = 80 mm Hg PO2 = 60 mm Hg Plasma Na+ = 140 mEq/L Cl- = 103 mEq/L

Which of the following most accurately describes the acid/base status of this patient? A. Metabolic acidosis, uncompensated B. Metabolic acidosis with compensatory respiratory alkalosis C. Metabolic alkalosis, uncompensated D. Metabolic alkalosis with compensatory respiratory acidosis E. Respiratory acidosis, uncompensated F. Respiratory acidosis with compensatory metabolic alkalosis G. Respiratory alkalosis, uncompensated H. Respiratory alkalosis with compensatory metabolic acidosis I. Combined (mixed) disorder, metabolic and respiratory acidosis J. Combined (mixed) disorder, metabolic and respiratory alkalosis

The correct answer is E. The patient's pH is acidotic, PCO2 = 80 mm Hg (respiratory acidosis), and the bicarbonate is the same level as would be expected from the PCO 2. This indicates that metabolism has not compensated for the acidosis. Metabolic compensation would increase the bicarbonate to 35-40 mEq/L. slow and shallow. Blood pressure is 110/70 mm Hg. Pulse is 90/min. His skin is warm and flushed. Laboratory results are not yet available. Which of the following would be the most accurate prediction of the patient's acid/base status, including compensation? A. Metabolic acidosis, uncompensated B. Metabolic acidosis with compensatory respiratory alkalosis C. Metabolic alkalosis, uncompensated D. Metabolic alkalosis with compensatory respiratory acidosis E. Respiratory acidosis, uncompensated F. Respiratory acidosis with compensatory metabolic alkalosis G. Respiratory alkalosis, uncompensated H. Respiratory alkalosis with compensatory metabolic acidosis I. Combined (mixed) disorder, metabolic and respiratory acidosis J. Combined (mixed) disorder, metabolic and respiratory alkalosis

The correct answer is F. Depressed ventilation increases arterial carbon dioxide, which causes respiratory acidosis. Because it has been 24 hours, some amount of renal compensation can be expected.

An increased plasma anion gap specifically indicates which of the following? A. Accumulation of organic acids in plasma B. Loss of bicarbonate in the urine C. Loss of bicarbonate in the feces D. Metabolic alkalosis E. Respiratory alkalosis

The correct answer is A. Loss of bicarbonate ions typically does not cause increased plasma anion gap. Alkalosis does not increase anion gap, except when metabolic acidosis occurs as a compensation. Accumulation of organic acids consumes bicarbonate ions, leading to decreased total anions. A healthy 30-year-old woman who has lived at sea level is on vacation in the Rocky Mountains at an elevation of 10,000 feet. She notices that she seems to be breathing more heavily than usual, but she has no symptoms of distress. After five days at this altitude, which of the following is her most likely acid/base status? A. Metabolic acidosis, uncompensated B. Metabolic acidosis with compensatory respiratory alkalosis C. Metabolic alkalosis, uncompensated D. Metabolic alkalosis with compensatory respiratory acidosis E. Respiratory acidosis, uncompensated F. Respiratory acidosis with compensatory metabolic alkalosis G. Respiratory alkalosis, uncompensated H. Respiratory alkalosis with compensatory metabolic acidosis I. Combined (mixed) disorder, metabolic and respiratory acidosis J. Combined (mixed) disorder, metabolic and respiratory alkalosis

The correct answer is H. The key is the observation that ventilation has increased in response to the hypoxia caused by high altitude. Increased ventilation lowers arterial PCO 2, causing respiratory alkalosis. Over the first several days, metabolic acidosis develops to compensate for the respiratory alkalosis. At the present time, she can best be described as having compensated respiratory alkalosis A 25-year-old woman with type 1 diabetes presents with severely elevated serum ketoacids. On physical examination, she is observed to have rapid, deep breathing. Lung fields are clear, and breath sounds are normal. Which of the following is the pattern of blood gases that would most likely be observed? = increased from normal = decreased from normal = unchanged

The greater the number of up or down arrows is, the larger the effect.

A. B. C. D. E. F.

The correct answer is A. This patient has diabetic ketoacidosis. The ketoacids cause decreased pH with low bicarbonate. The compensatory response is to increase ventilation, which is noted in this patient. Increased ventilation causes decreased PaCO 2; low arterial carbon dioxide reduces acid but further decreases bicarbonate production. The result is a patient with marked acidosis, low arterial PCO2, and very low arterial bicarbonate. Choice B would be a combined disorder, with both metabolic and respiratory acidosis. Choices D, E, and F are eliminated because the primary disorder is acidosis caused by increased ketoacids.